Schedule 3 Procedures

Common occurrence Concave side of pinna Pressure is very painful

Common causes: self-inflicted trauma, head shaking, scratching, rubbing ear against objects

External causes: poor ear conformations, immune mediated, food allergies, hypersensitivities, ear mites

The underlying cause must be treated, otherwise haematoma will return after surgery!

Discuss costs with owner preoperatively - if underlying causes is dermatological some of treatments could be expensive

Draining technique: Draining haematoma with a needle & syringe +/- instilling steroid Rarely tolerated or curative Usually fills with blood again

If left untreated - it will eventually resolve itself but it is painful due to fibrous contracture of tissues causing permanent damage and pinna deformity

Surgical technique:1. Anaesthetise patient2. Clip hair and surgically prepare skin3. Make a longitudinal, s-shaped incision4. Removed blood and fibrin clot5. Curette cavity6. Flush with sterile saline7. Use 2.0/3.0/4.0 nylon/polypropylene suture material and swaged on straight cutting needle8. Place horizontal mattress sutures, including all layers of pinna, in 2-5 rows parallel to incision9. Tie sutures to convex side of pinna

Complications: Delay in treatment or sutures placed too tight - irreversible cosmetic alterations to the pinna Recurrence of haematoma is high (adjacent to original) - inadequate suture numbers or underlying cause of ear disease not treated

Consequences of poor technique - avoid 3 main branches of auricular artery & avoid placing sutures perpendicular to wound

WORST CASE SCENARIO: OCCLUSION RESULTS IN DIMINISED BLOOD SUPPLY --> PINNA NECROSIS

Suture less technique:1. Clip and surgically prepare skin2. Make elliptical incision in skin, curette and lavage with sterile saline3. Tape either side of wound and reflect the pinna over some padding on top of head - similar to ear bandage4. Put absorbent dressing (Alleyvn) over top of incision - change as necc depending on exudate. But keep in place for 3 weeks5. Pinna completely immobilised, allowing drainage and healing by 2nd intention. By not using sutures, the pinna is kept flat which prevents thickening, wrinkling during healing. But only if animal does not interfere with it!

Fine Needle Aspirate Body: 1st step if fluid filled mass suspected Valuable diagnosis for mast cell tumours Performed without sedation/GA 1. Clip and scrub skin over mass - to make more visible and avoid introduction of bacteria2. Immobilise mass with one hand whilst operating needle/syringe with other3. Insert needle into mass4. Create negative pressure by pulling syringe plunger back to 5-10mls5. Whilst maintaining negative pressure, redirect needle about 2-5 times within mass6. Release plunger and remove needle from mass7. If blood is drawn, remove needle and change equipment8. Detach syringe and fill with air9. Reattach to needle and depress plunger to expel contents onto one or more slides10. Deposit sample close to one end of slide11. Place clean slide on top of sample and pull them away from each other

Core needle biopsy: To obtain a cylinder of tissue from a solid mass LA or sedation required Trucut biopsy needle

Incisional biopsy: To surgically remove a slice of tissue It helps to include a margin of normal tissue to compare pathology results too Risk of transferring potential tumour cells

Excision of a subcut mass (eg. lipoma):1. Use a scapel and incise skin over mass2. Use blunt and sharp dissection scissors to separate mass from surrounding tissues3. Hold tissue to be excised with rat-tooth or tissue forceps4. S/c tissue is abundant in most sites so excise some without too much concern5. Deal with haemorrhage as appropriate. Attempt to identify these and clamp before cutting6. Close dead space with an absorbable suture in a continuous pattern with rat-toothed forceps and needle holders7. Close the skin - non-absorbable, simple, interrupted skin suture

Excision of masses involving the skin:1. Make an elliptical insicion around mass2. Include a border of at least 1.5cm of normal tissue3. Use blunt and sharp dissection scissors to separate mass from surrounding tissue4. Deal with haemorrhage5. Close dead space and skin

Skin incision: Greatly affects end result of procedure Skin should only be cut with a scapel, crushing effect of scissors will impair wound healing Striaghts incisions will close neatly Elliptical incisions should have sides of equal length to facilitate neat closure

Subcutaneous dissection: Handle abnormal tissue as little as poss and avoid cutting it - reduce risk of spreading disease into remaining tissue Cutting causes less trauma to remaining tissues, but blunt dissection allows mass to be isolated more easily Blunt dissection can be achieved by splitting tissues between fingers, wiping tissues with swab or opening scissors

Subcutaneous closure: Important to eliminate dead space that is left following excision, to prevent seroma formation Can be reduced with surgical drains, suturing is utilised more frequently S/c tissue (muscle/fat) holds tension poorly so do not tie sutures too tightly Tight enough to appose tissue though

Skin closure: Should be achieved by neatly apposing edges of wound Excessive tension should be avoided Suture material, staples or adhesive can be used and choose appropriate suture pattern according to wound

Lancing:1. Surgically prepare area over abscess2. Lance over soft point with a stab incision using a scalpel blade3. Pus is expressed4. Cavity is flished with sterile saline or antiseptic solution5. Continue flushing until fluid is clear. Digitally explore cavity to breakdown any pockets and flush again6. Occassionally a drain is inserted7. Aftercare includes daily flushing of cavity until contracted or filled with granulation tissue8. Incision bathed and kept open initially to allow drainage

Aural Haematoma Surgery

Skin Mass Removal & Biopsies

Abscesses